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What is The CIWA Protocol?

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The CIWA protocol is a tool that can be used for evaluating the intensity of alcohol withdrawal symptoms in those grappling with alcohol dependency.

Given that severe withdrawal symptoms can pose life-threatening risks, it is imperative to engage with appropriate medical attention and care throughout the detox process. Detoxing from alcohol at home is never advisable. 

CIWA (Clinical Institute Withdrawal Assessment for Alcohol) is an assessment scale recognized for its accuracy in gauging the severity of alcohol withdrawal symptoms.

The Ciwa Protocol for Alcohol Withdrawals

If you’re investigating alcohol detox and treatment programs, you may have many questions, including, “What is CIWA protocol?” and “What does CIWA medical abbreviation mean?”.

CIWA protocol (commonly misspelled as SIWA protocol) is also known as the CIWA-Ar score. Specifically, CIWA-Ar is a refined and abbreviated version of the original Clinical Institute Withdrawal Assessment for Alcohol that was developed to standardize the treatment of those experiencing alcohol withdrawal and improve treatment outcomes. The CIWA protocol originally comprised 30 items, but the revised CIWA-Ar version, consisting of 10 items, was introduced as an improved and more concise alternative. This revised scale has become the most widely utilized tool for assessing the severity of alcohol withdrawal symptoms and is recognized for its accuracy.

Employing the CIWA-Ar scale enables healthcare providers to adopt the most appropriate approach in managing alcohol withdrawal. The scale can be utilized in either inpatient or outpatient settings, helping guide the scope of treatment based on the scores obtained. For instance, a patient with a higher score may require more intensive interventions like intravenous fluids or medications, while a patient with a lower score might need less intensive treatment during detox. Besides assessing symptom severity, the CIWA protocol also allows health providers to monitor the patient’s response to treatment.

The CIWA protocol finds application in various healthcare scenarios, including:

  • Inpatient detoxification: CIWA detox is commonly employed for patients undergoing alcohol detox in a residential setting. The scale helps in assessing the severity of withdrawal symptoms and provides guidance for treatment intensity.
  • Outpatient management: The CIWA protocol can be utilized in a range of outpatient settings to evaluate the intensity of symptoms and monitor the individual’s response to treatment.
  • Emergency departments: In certain cases, the CIWA protocol may be used in the emergency department for the assessment and management of alcohol withdrawal.
  • Research: The CIWA protocol has also been utilized in research studies focusing on the treatment of alcohol withdrawal, enabling standardized assessment and data collection.

By utilizing the CIWA protocol, healthcare professionals can better evaluate and manage the symptoms of alcohol withdrawal, ensuring appropriate care and treatment tailored to each individual’s needs.

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CIWA-AR Assessment

The CIWA assessment (or the revised CIWA-Ar assessment) is intended to be conducted by licensed physicians within a professional medical setting. It is commonly employed by various healthcare professionals, including family doctors in their practices, as well as physicians working in residential and outpatient addiction treatment programs. These trained medical professionals utilize CIWA as part of their comprehensive approach to evaluating and managing alcohol withdrawal symptoms in order to provide the right level of care for their patients.

CIWA Alcohol Withdrawal Scale

The CIWA protocol consists of ten items that are assessed and scored on a scale of 0 to 7, except for the final item, which uses a scale of 0 to 4. Higher scores indicate more severe symptoms of alcohol withdrawal. The scoring is based on a combination of the patient’s self-reported symptoms and observable signs. Administering the assessment typically takes two minutes.

The following are the score ranges and their corresponding meanings:

  • 7 and below: Minimal to mild alcohol withdrawal.
  • 8 to 15: Moderate alcohol withdrawal.
  • 16 or more: Severe alcohol withdrawal, indicating a heightened risk of DTs (delirium tremens).

The ten items covered by the CIWA protocol encompass the following categories:

  1. Agitation
  2. Anxiety
  3. Headache
  4. Nausea/vomiting
  5. Tremor
  6. Visual disturbances
  7. Auditory disturbances
  8. Tactile disturbances
  9. Clouding of sensorium
  10. Paroxysmal sweats

CIWA Score

The CIWA-AR assessment assigns scores on a scale of 0 to 7 for each of the ten symptoms and can be completed in just two minutes. By totaling the scores for each symptom, physicians can determine the severity range of a patient’s withdrawal syndrome.

Cumulative scores of below 8 in the CIWA-AR assessment are indicative of mild alcohol withdrawal symptoms. Scores ranging from 8 to 15 suggest moderate withdrawal symptoms, while scores of 15 or higher indicate severe symptoms of alcohol withdrawal, which may be associated with the potential onset of delirium tremens.

CIWA Detox Protocol

The CIWA detox protocol is a crucial component of alcohol addiction treatment, especially during the detoxification phase. It provides a structured framework for managing alcohol withdrawal symptoms to ensure the safety and well-being of individuals undergoing detox. By administering alcohol withdrawal CIWA detox, a treatment team can closely monitor a patient’s withdrawal symptoms and determine the most effective interventions. The scores obtained from CIWA questions help influence treatment decisions, including the need for medications, intravenous fluids, or other supportive measures.

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Get Alcohol Addiction Treatment at Ohio Recovery Centers

At Ohio Recovery Centers, we recognize that alcohol addiction is a multifaceted problem that demands a comprehensive approach. That’s why we provide specialized outpatient programs designed to address alcohol addiction while you remain anchored to your everyday commitments.

If you’re battling alcohol addiction, we can connect you with licensed medical detoxification facilities throughout Cincinnati, OH to help you withdraw from alcohol as safely and comfortably as possible. Once you successfully complete detox, we offer a range of alcohol addiction treatment programs, including partial hospitalization programs, intensive outpatient programs, and dual diagnosis treatment programs, to support your transition into ongoing recovery.

Our team of medical experts and addiction specialists employs evidence-based treatments like medication-assisted treatment, behavioral therapies, and counseling alongside holistic interventions to deliver comprehensive care tailored to your unique needs.

We also understand that recovery is an ongoing journey that necessitates continuous support. That’s why our Cincinnati rehabilitation center incorporates a robust aftercare component to enhance your prospects of maintaining long-term recovery without relapse.

If you need assistance tackling alcohol addiction, we are here to guide you throughout the recovery process. Contact us today at (877) 679-2132 for immediate support regarding alcohol addiction treatment.

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Joseph Gilmore

Joseph Gilmore has been working in the addiction industry for half a decade and has been writing about addiction and substance abuse treatment during that time. He has experience working for facilities all across the country. Connect with Joe on LinkedIn.
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Christopher Glover CDCA

My name is Christopher Glover, and I am from Cincinnati, Ohio. I am currently in school and working to grow in competence to better support our community. As a recovering individual I know the struggles that you or a loved one can go through and that there is help for anything you may be struggling with.

The hardest part is asking for help and we are here as a team to best support you and your decision to start your journey towards a better future. Connect with Chris on LinkedIn

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Amanda Kuchenberg PRS CDCA

I recently joined Ohio Community Health Recovery Centers as a Clinical Case Manager. I am originally from Wisconsin but settled in the Cincinnati area in my early 20s.  My career started in the fashion industry but quickly changed as I searched to find my drive and passion through helping others who struggle with addiction. 

As someone who is also in recovery, I wanted to provide hope, share lived experience, and support others on their journey.  I currently have my Peer Recovery Support Supervision Certification along with my CDCA and plan to continue my education with University of Cincinnati so I can continue to aid in the battle against substance addiction. Connect with Amanda on LinkedIn.

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Patrick McCamley LCDC III

 Patrick McCamley (Clinical Therapist) is a Cincinnati native who has worked in substance use disorder/co-occurring mental health disorder treatment since 2019. Patrick received his bachelors degree in psychology from University of Cincinnati in 2021 and received his LCDC III (Licensed Chemical Dependency Counselor) license from the Ohio Chemical Dependency Professionals Board in 2022. Patrick has worked in Clinical Operations, Clinical Case Management, and Clinical Therapy throughout his career.

Patrick has tremendous empathy and compassion for the recovery community, being in recovery himself since 2018. Patrick is uniquely qualified to be helpful because of the specific combination of his academic background and his own experience in recovery.

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Bill Zimmerman CDCA

Bill Zimmerman is a Greater Cincinnati Area native who has worked in substance use disorder/co-occurring mental health disorder treatment since 2018. Bill received his (Chemical Dependency Counselor Assistant) license from the Ohio Chemical Dependency Professionals Board in 2020.

Bill has worked in Clinical Operations in both support and supervision, and Program facilitating and 12 step recovery support during his career. Bill has a passion for the recovery community, having been in recovery himself since 1982. Connect with Bill on LinkedIn

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Taylor Lilley CDCA, PRS

Growing up in Louisiana with addiction running rampant on both sides of my family. A life away from drugs and alcohol seemed impossible for someone like me. I remember what it was like sitting across from someone thinking there is no way they could ever understand what I was going through.

Sharing my experience offers a credibility and a certain type of trust with clients that only someone who has walked down this road can illustrate. To immerse myself further into the field of addiction, I am currently studying at Cincinnati State for Human and Social Services.  I hope I never forget where I came from, if I can do it, so can you!

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Thomas Hunter LSW

Hello my name is Thomas Hunter. I was born and raised in Cincinnati, Ohio. I am a licensed social worker.In my scope of practice I have worked in the areas of mental health and recovery for thirty years. The clients I have worked with in my career have ranged in age from seven to seventy.

I strive each day to serve my purpose of helping those in need and I believe I do so by utilizing all of my experiences to accomplish my goal of supporting those who desire to establish their sobriety and maintain it in their recovery. Connect with Thomas on LinkedIn.

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Mary D.Porter,LICDC

 My name is Mary D. Porter. I received my Masters of Social Work in 2008 from The University of Cincinnati. I received My Licensed Independent Chemical Dependency Counselor Licensure in 2001. I retired from The Department of Veteran Affairs Medical Center on April 14, 2014. Currently, I am the Associate Clinical Director for The Ohio Community Health Recovery Centers in Cincinnati.. Due to the fourth wave of the Opioid Epidemic in 2019,  I decided to enter back into the workforce to assist the addicted population.

The overdoses were astounding and I wanted to help.  I consider myself  to be an advocate for the addicted population. My compassion, resilience, empathy, wisdom, knowledge, experience and  love I have for this forgotten population goes beyond words. I consider what I do for the addicted population as a calling versus a “career,” because I too was once an “addict and alcoholic.” Today I am 45.5 years alcohol and substance free.

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Ben Lemmon LCDC III

Hello, my name is Ben Lemmon, and I’m the Vice President and Clinical Director at Ohio Community Health Recovery Centers. I’ve been working in the addiction and mental health field since 2013 and decided to enter the field after overcoming my own challenges with addiction.

When I first meet a client, I always explain to them that the reason we are meeting is because they are not capable of obtaining or maintaining sobriety, and my goal is to create a person that can maintain sobriety. I believe a person’s personality is made up of their thoughts, feelings and actions and my job is to help clients identify the thoughts, feelings and actions that have them disconnected from recovery and provide them with the tools to live a healthy and happy life. Connect with Ben on LinkedIn